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Fetishistic disorder is an intense sexual attraction to objects or body parts not traditionally viewed as sexual, coupled with clinically significant distress or impairment.

Definition

The term “fetishism” was coined in the late 1800s. It originates from the Portuguese word feitico, which means “obsessive fascination.” There is a degree of fetishistic arousal in most normal individuals who find particular bodily features attractive. However, fetishistic arousal is generally considered a problem when it interferes with normal sexual or social functioning and where sexual arousal is impossible without the fetish object.

Fetishistic disorder is characterized as a condition in which there is a persistent and repetitive use of or dependence on nonliving objects (undergarments or a high-heeled shoe) or a highly specific focus on a body part (typically nongenital) to reach sexual arousal. Only through use of this object or body part can the individual obtain sexual gratification. A diagnosis of fetishistic disorder is only used if there is accompanying personal distress or impairment in social, occupational, or other important areas of functioning as a result of the fetish. People who identify as fetishistic practitioners but do not report associated clinical impairment would be considered as having a fetish but not fetishistic disorder.

Common fetish objects include female undergarments, footwear, gloves, rubber articles, and leather clothing. Body parts associated with fetishistic disorder include feet, toes, and hair. It is common for the fetish to include both inanimate objects and body parts, such as dirty socks and feet. For some, merely a picture of the fetish object may cause arousal, though most prefer or require the actual object. The fetishist usually holds, rubs, tastes, or smells the fetish object for sexual gratification or asks their partner to wear the object during sexual encounters. For a diagnosis of fetishistic disorder to be given, the fetish objects must not be limited to articles of clothing used in cross-dressing (as in transvestic disorder) or devices designed specifically for purpose of genital stimulation (vibrators, dildos).

Inanimate object fetishes can be categorized into two types: form fetishes and media fetishes. In a form fetish, the object and its shape are important, such as high-heeled shoes. In a media fetish, the material of the object is important, such as silk or leather. Inanimate object fetishists often collect the object of their favor. In some cases, the fetishism is severe enough to inspire the fetishist to acquire objects of his desire through theft or assault. Male fetishists may be unable to get erections without the presence of the objects.

Fetishistic disorder is a much more common occurrence in males, and the causes are not clearly known. Fetishism falls under the general category of paraphilic disorders, which refers to intense sexual attraction to any objects or people outside of genital stimulation with consenting adult partners.

Symptoms

The sexual acts of people with fetishistic disorder are characteristically focused exclusively on the fetish object or body part. Non-fetishists may at various times become aroused by a particular body part or an object and make it a part of their sexual interaction with another person, but they do not fixate on it.

In general, the person with fetishistic disorder can only become sexually aroused and reach orgasm when the fetish is being used. In other instances, a response may occur without the fetish, but at a diminished level. When the fetish object is not present, the fetishist fantasizes about it.

The diagnostic criteria for fetishism includes:

For a period of at least six months, the person has recurrent, intense sexually arousing fantasies, urges or behaviors involving nonliving objects (such as female undergarments and shoes) or a highly specific focus on nongenital body part(s).

The fetish objects are not articles of clothing used in cross-dressing (as in transvestic disorder) and are not designed for tactile genital stimulation, such as a vibrator.

People with fetishistic disorder may seek employment or volunteer work to enable their behavior—for example, a job in a shoe shop in the case of a shoe fetish.

Common types of fetishistic disorder include:

Amputee fetishism

Breast fetishism

Corset fetishism (Tightlacing)

Diaper fetishism

Foot fetishism

Food fetishism

Furry fetishism/Toonophilia

Glove fetishism

Leather fetishism

Medical fetishism

Pregnancy fetishism

Rubber fetishism

Boot fetish

Spandex fetishism

Stocking fetishism

Swim cap fetishism

Belly button fetish

Causes

Paraphilias such as fetishistic disorder typically have an onset during puberty, but fetishes can develop prior to adolescence. No cause for fetishistic disorder has been conclusively established.

Some theorists believe that fetishism develops from early childhood experiences, in which an object was associated with a particularly powerful form of sexual arousal or gratification. Other learning theorists focus on later childhood and adolescence and the conditioning associated with masturbation activity.

Behavioral learning models suggest that a child who is the victim or observer of inappropriate sexual behaviors learns to imitate and is later reinforced for the behavior. Compensation models suggest that these individuals are deprived of normal social sexual contacts and thus seek gratification through less socially acceptable means. In the far more common cases involving males, the patterns suggest that causes stem from doubts about ones own masculinity, potency, and a fear of rejection and humiliation. By his fetishistic practices and the mastery over an inanimate object, the individual may safeguard himself and also compensate for some of his feelings of inadequacy.

Treatments

Fetishistic fantasies are common and should only be treated as a disorder when they cause distress or impair a person’s ability to function normally in their day-to-day life.

Fetishistic disorder tends to have a continuous course that fluctuates in intensity and frequency of urges or behavior along the life course. As a result, effective treatment is usually long-term. Treatment approaches have included various forms of therapy (traditional psychoanalysis, hypnosis, cognitive and behavior therapy) as well as medication therapy (SSRI’s, androgen deprivation therapy). Some prescription medications help to decrease the compulsive thinking associated with the paraphilias. This allows concentration on counseling with fewer distractions from the paraphiliac urges. Increasingly, the evidence suggests that combining drug therapy with cognitive behavior therapy can be effective, although research on the outcome of these therapies remains inconclusive. A class of drugs called antiandrogens can drastically lower testosterone levels temporarily and have been used in conjunction with other forms of treatment for fetishistic disorder. This medication lowers sex drive in males and reduces the frequency of sexually arousing mental imagery.

The level of sex drive is not consistently related to the behavior of paraphiliacs and high levels of circulating testosterone do not predispose a male to paraphilias. That said, hormones such as medroxyprogesterone acetate (Depo-Provera) and cyproterone acetate help decrease the level of circulating testosterone, thus reducing sex drive and aggression and resulting in a reduction of the frequency of erections, sexual fantasies and initiation of sexual behaviors including masturbation and intercourse. Hormones are typically used in tandem with behavioral and cognitive treatments. Antidepressants such as fluoxetine (Prozac) have also successfully decreased sex drive but have not effectively targeted the presence of sexual fantasies.

Research suggests that cognitive-behavioral models are effective in treating people with paraphilic disorders. Aversive conditioning involves using negative stimuli to reduce or eliminate a behavior. Covert sensitization entails the patient relaxing and visualizing scenes of deviant behavior followed by a negative event. Assisted aversive conditioning is similar to covert sensitization except the negative event is made real (foul odor pumped in the air by the therapist). The goal is for the patient to associate the deviant behavior with the negative event (foul odor) and take measures to avoid the negative event by avoiding said behavior.

Reconditioning techniques center on immediate feedback given to the patient so that the behavior will change right away. For example, a person might be connected to a biofeedback machine that is linked to a light, the person is taught to keep the light within a specific range of color while the person is exposed to sexually stimulating material. Masturbation training might focus on separating pleasure in masturbation and climax from the deviant behavior.